Circular Stapled Haemorrhoidectomy

An operation to remove haemorrhoids/Piles.

This tells you what the operation involves, what to expect in the recovery period, and the possible risks, questions . Please speak to the doctor or ward staff when you come to the hospital.

1. What are haemorrhoids (piles) ?

Haemorrhoids, also known as piles, are enlarged and swollen blood vessels in or around the lower rectum and the anus.

2. What causes haemorrhoids ?

Constipation, pregnancy and children, obesity and straining e.g. while lifting or vomiting; can contribute to the development of haemorrhoids.

3. Circular Stapled Haemorrhoidectomy.

Your surgeon has recommended that you have an operation to remove your haemorrhoids. Surgery is needed for certain types of haemorrhoids, or where other forms of treatment have not worked.

4. What does the operation involve?

A stapled haemorrhoidectomy is an operation to return the haemorrhoids to a normal position inside the rectum (back passage). A circular shaped stapling device is gently inserted to back passage. The surgeon uses the device to remove excess tissue above the haemorrhoids, and then staples the remaining tissue back inside the rectum. The staples are left permanently in the body.

Stapled haemorrhoidectomy is a relatively new technique, developed in Europe in the early 1990’s, we have been doing it for last 10 years.

5. Are there any alternatives?

It is important to try all non- surgical treatments before considering haemorrhoidectomy. This includes making improvement to your diet, avoiding straining (e.g. when lifting) and lifestyle changes to improve your bowel function. Haemorrhoids may also respond to the relatively simple treatment of banding or injection.

Stapled haemorrhoidectomy is effective as the traditional alternative, the surgical removal of haemorrhoids. It is also tends to be more painful and usually requires a long periods of recovery.

6. What are the benefits of haemorrhoidectomy

The main benefits are the relief of pain, bleeding, discharge and itching caused by haemorrhoids.

7. What are the risks?

Haemorrhoidectomy is considered a safe procedure. However, as with any surgery, complication do something occur :

Bleeding after surgery the operation. The bleeding often stops on its own but sometimes further surgery may be needed to correct it.

Excessive bleeding may occur upto 14 days after surgery and rarely this may result in being re-admitted to hospital for observation or treatment (0.5 to 1%).

If too much muscle tissue is drawn into the device, it can damage the rectal wall resulting in inflammation or infection.

Urgency (the need to rush to the toilet). This can last up to a year.

The internal muscles of the sphincter (entrance to the back passage) may be damaged, resulting in long-term dysfunction, such as severe pain or incontinence.

Immediately after surgery you may also experience some difficulty in passing urine, but this should pass. Occasionally a catheter might be required to empty the bladder.

Further rare complications of surgery include deep vein thrombosis (blood clot), pulmonary embolism (blood clot in the lung), and narrowing of the anus (stenosis).

A very small number of patients have reported long term pain.

8. What would happen if my haemorrhoids were left untreated?

Untreated haemorrhoids can drop down outside the canal and become strangulated (twisted) causing pain.

Haemorrhoids can cause the leaking of mucous, and inflammation and irritation of the skin around the anus.

Untreated haemorrhoids can also bleed, so you could become anaemic.

9. What happens after the operation?

If an anal plug has been inserted this will usually be removed a few hours after surgery. If a dissolvable anal plug has been this will be passed on your first bowel movement.

You can also expect a small amount of bleeding. You may experience some surgery needing to get the toilet quickly, and some people have reported pain that lasts months or even years.

10. Going Home

If your operation is planned as a day case you can go home as soon as the effect of the anaesthetic has worn off and you are comfortable, eating and drinking, and the nurse has checked

your blood pressure & pulse, & bleeding are stable.

A general anaesthetic can temporarily effect your co-ordination and reasoning skills so you will need a responsible adult to take you home stay with you for the first 24 hours.

11. Will the haemorrhoids return after surgery?

Haemorrhoids can return after any form of treatment, but they are less likely to do so after having a haemorrhoidectomy. If they do return, another haemorrhoidectomy or other form of treatment may be necessary. However, attention to diet and bowel function will help to reduce the chance of recurrent problems.

12. Getting back to normal.

You can return to normal physical and sexual activities when you feel comfortable.

How much pain can I expect?

At times the pain may be significant, so taking regular painkiller will help. Warm bath may also help reduce any discomfort. You may experience discomfort for several weeks after the operation.

Bowel action and personal hygiene.

It is important to maintain a regular bowel movement that should be well formed bur soft. Continue to take laxative for two weeks after your surgery.

Eating a high fibre diet and increasing your fluid intake will also help. You will normally open your bowel within 2-3 days of your operation – this may be uncomfortable at first.

You may notice blood loss after each bowel movement but this will gradually reduce over the next few weeks. It is important to keep the operation site clean. If possible, wash after each bowel movement for 3-4 weeks after the operation.

Bathing once or twice a day is also soothing and may reduce discomfort. The cut area may take a month or more to heal properly and during this time there may be a slight discharge. Small pad inside your pants will protect your clothes from any staining.